Blogging from the Neuroethics Society Annual Meeting 2008

SATURDAY, NOVEMBER 15, 2008

Leaping from bench to business

Some advances in neuroscience, especially those related to neurotechnologies, offer big business opportunities, panelists said during the second day of the Neuroethics Society’s annual meeting in Washington, D.C.

Nearly one in three people, or about 2 billion worldwide, will develop a mental condition such as addiction, anxiety, depression, chronic pain or dementia during their lives, he said.

In 2007, global neurotech industry revenue rose 8.3 percent to $130.5 billion; it had risen 10 percent the previous year. Venture capitalists are bullish, too, with investment of $1.77 billion last year, representing 20 percent of all investment in life-sciences businesses, according to a survey by NeuroInsights.

More than 100,000 people worldwide already have the neurodevices called cochlear implants, which allow for better hearing, said Martha Farah of the University of Pennsylvania. Techniques such as transcranial magnetic stimulation, an outside-the-head magnetic technique approved to treat some forms of depression, might “be coming to a brain spa near you any day,” she said.

“We are seeing neuroscience and its applications becoming ‘disruptive technologies,” Farah said, which are not incremental improvements but “fundamental game-changers” in their fields.

Lynch agreed: “The implications of brain improvement” through neuropharmaceuticals, neurodevices and neurodiagnostics will be as far-reaching as the spread of electricity or computing, he said.

These fields have the potential for great good, but also for great ills, Farah said. Should researchers who are also businesspeople declare potential conflicts of interest in their reporting? How can consumers be sure an unregulated neuro-product is safe and effective? How do we ensure fairness if some people can afford brain-improving drugs and others can’t—or do we wish to ensure such fairness? How do we ensure privacy?

And who decides if a worker must take a brain-improving drug—his or her employer? “Mental health is the ultimate competitive resource,” Lynch said, and neurotechnology could improve memory retention and decrease the incidence of anxiety and stress. “Even if only a small group of people takes them, it will reshape the economy,” he said, noting that likely early adopters would be people in the financial industries, such as market traders.

FRIDAY, NOVEMBER 14, 2008

Truth telling on lie detection

How should we take companies’ claims that their functional magnetic resonance imagers (fMRI) can tell if we are telling lies? With a mighty grain of salt, said panelists during the second day of the Neuroethics Society’s annual meeting in Washington, D.C.

“Over the past 6 years, the press assumed fMRI was better than lie detection,” he said. “But no one really knows.” One reason is few controlled or real-world tests of the technology have been done; another is that people can confound lie-detection, whether a person is saying something they think is a lie, and mind reading.

In carefully controlled tests, with white male college students without known medical conditions and not on drugs, Langleben said, “we could sometimes detect deception,” but not always.

“There is no perfect lie detector,” said Steve Laken of Cephos Corp., which offers fMRI scanning to the public. Like standard lie detectors, fMRI “could be a forensic tool, not a definitive tool but a forensic tool,” he said. Cephos’s method has “78-97 percent accuracy,” according to the company’s research.

But the vast majority of his clients do not wish to prove lies but to show that they are telling the truth, he said. “Prosecuting attorneys and DAs aren’t interested; defenders are.” The company has a long list of explanations included on the informed-consent forms it requires clients to sign before administering tests, including the caveat that the client might not like the outcome. Cephos ensures that the people doing the scanning don’t know the details of the case and neither do the off-site researchers reading the images.

If the images light up the right way, “we say they believe what they’re saying is true,” Laken said, not that it is factually true.

Imaging for lie detection is just the first of a variety of neuroscience-based tests that will have legal implications, Greely said. Others include tests that might, in the future, detect levels of pain (for personal injury litigation) and whether we recognize people or crime sites. And interest is high: “The law is really interested in someone’s mental state,” he said.

Greely disagrees that fMRI for lie detection would be just another piece of forensic technology. “It is science saying this person is a liar, this person is telling the truth,” he said. Some studies show that simply showing a person information accompanied by an unrelated picture of a brain scan leads the person to think the information is true. “It is reckless, and so unethical, to proceed [with this technology] with so little knowledge if it is good—or good enough.”

What should we do? “It would be nice to have some regulation,” Laken said, but people disagree on what level to recommend and what agency should do it. In the short term, we could regulate the use of fMRI devices under standard medical regulations, just as we do other medical devices, suggested Langleben.

THURSDAY, NOVEMBER 13, 2008

Illness as social change

The first discussion at the inaugural annual meeting of the Neuroethics Society today, on the neuroethics of pediatric bipolar disorder, felt a little like déjà vu to me.

Fifteen to 20 years ago, nearly no child was labeled bipolar, said panelist Benedetto Vitiello of the National Institute of Mental Health; since then the number of diagnoses has jumped. “It’s really staggering … to go from practically nothing to nearly an epidemic,” said panelist Steven Hyman of Harvard. But the rise is not because children never acted out or had social problems until a decade ago; rather, we labeled it something else—or it wasn’t considered a problem.

“Because we are so focused on the pathological, we can miss the wide range of normal,” said panelist Josephine Johnston of the Hastings Center, who co-authored a briefing book on mental health in children and adolescents on the Center’s Web site. And diagnosing a child wrongly with bipolar disorder can stigmatize her as well as lead well-meaning parents to dose her with strong drugs that not only won’t fix the problem but could cause worse behavior—and serious physical complications.

This theme has come up twice during this past month here, at a forum held at the Dana Center on understanding childhood brain disorders and in “The meaning of psychological abnormality,” the current article in Cerebrum. To make her point, Johnston even read a quote from Cerebrum: “The contemporary American economy requires every child to complete high school with adequate language and mathematical skills, and preferably go on to receive a college degree, in order to obtain a job with some financial security. These were not requirements in the 18th century; Benjamin Franklin did not have the advantage of a high school education.”

Social constructions such as high achievement in education, which often means having the self-control to sit still for hours on end, are real in our lives, she said. “In seeking to change the child, we might also need to change the child’s context.”

Jerome Kagan (who also wrote the Cerebrum piece) spells out the argument against calling the jump in childhood disorder diagnoses an epidemic in the Webcast of the Dana Center forum, about 10 minutes into the piece.